Efficacy of Flour Fortification with Folic Acid in Women of Childbearing Age in IranAbdollahi Z.a · Elmadfa I.f · Djazayery A.b · Golalipour M.J.e · Sadighi J.c · Salehi F.a · Sadeghian Sharif S.d
aNutrition Department, Ministry of Health and Medical Education, bDepartment of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Science, cInstitute for Health Sciences Research, Academic Center for Education, Culture and Research, and dEndocrine Research Center, Shahid Beheshti University of Medical Science, Tehran, and eGorgan Congenital Malformations Research Center, Gorgan University of Medical Sciences, Gorgan, Iran; fDepartment of Nutritional Science, University of Vienna, Vienna, Austria
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: Flour fortification with folic acid is one of the main strategies for improving folate status in women of childbearing age. No interventional trial on the efficacy of folic acid fortification has been conducted so far in Iran. Objectives: To study the effects of flour fortification with folic acid on any reduction in neural tube defects (NTDs) and folate status of women of childbearing age. Methods: In a longitudinal hospital-based study, 13,361 postpartum women were studied after admission for childbirth before and after fortification. In addition, two cross-sectional surveys were conducted before (2006) and after flour fortification (2008). The cluster sampling method was used and 580 women, 15–49 years old, were studied as a representative sample of Golestan province in the north of Iran. Fasting blood samples were collected to measure serum vitamin B12, folate and plasma homocysteine. Sociodemographic data, health characteristics and dietary intake were determined. Results: The mean daily intakes of folate from natural food before and after flour fortification were 198.3 and 200.8 µg/day, respectively. The total folate intake increased significantly from 198.3 to 413.7 µg/day after fortification (p < 0.001). Folate intake increased by an average of 226 µg/day from fortified bread. The mean serum folate level increased from 13.6 to 18.1 nmol/l; folate deficiency decreased from 14.3 to 2.3% (p < 0.001). The incidence rate of NTDs declined by 31% (p < 0.01) in the post-fortification period (2.19 per 1,000 births; December 2007 to December 2008) compared to the pre-fortification period (3.16 per 1,000 births; September 2006 to July 2007). Conclusions: Implementation of mandatory flour fortification with folic acid can lead to a significant increase in serum folate and a significant decrease in NTDs.
© 2011 S. Karger AG, Basel
- Detrait ER, George TM, Etchevers HC, Gilbert JR, Vekemans M, Speer MC: Human neural tube defects: developmental biology, epidemiology, and genetics. Neurotoxicol Tetratol 2005;27:515–524.
Brand MC: Examination of the newborn with closed spinal dysraphism. Adv Neonatal Care 2007;7:30–40.
- Kaufman BA: Neural tube defects. Pediatr Clin North Am 2005;51:389–419.
Allen LH, Benoist B, Dary O, Hurrell R: Guideline of Food Fortification with Micronutrients. Geneva, World Health Organization, Food and Agricultural Organization of the United Nations, 2006.
Ministry of Health and Medical Education: National Integrated Micronutrients Survey (NIMS) in Islamic Republic of Iran. Tehran, Ministry of Health and Medical Education, 2001.
Behrooz A: Prevalence of neural tube defect and its relative factors in south-west of Iran. Pak J Med Sci 2007;23:654–656.
Mohammadbegi R, Rahimi E: Neural tube defects in newborns in Bacat hospital of Sannadaj in Kordestan province in Iran. Kordestan Univ MedJ 2002;6:36–40.
Nalubola R, Nestel P: Manual for Wheat Flour Fortification with Iron. 3. Analytical Methods for Monitoring Wheat Flour Fortification with Iron. Arlington, MOST Project, 2000.
Johnson Q, Maner V, Ranum P: Fortification Handbook: Vitamin and Mineral Fortification of Wheat Flour and Maize Meal. Section 10: Quality Assurance and Control. The Micronutrient Initiative 2004, pp 74–78.
Dorosty AR: Iranian food composition software. Tehran, Tehran University of Medical Sciences, 2003.
Food Standards Agency: McCance and Widdowson’s the Composition of Foods: Summary Edition, ed 6. Cambridge, Royal Society of Chemistry, 2004.
World Health Organization: International Statistical Classification of Diseases and Related Health Problems (ICD-10). Geneva, World Health Organization, 2007.
- Ubbink JB, Vermaak WJH, Bissbort S: Rapid high-performance liquid chromatographic assay for total homocysteine levels in human serum. J Chromatogr 1991;565:441–446.
Sauberlich HE: Laboratory Tests for the Assessment of Nutritional Status, ed 2. Boca Raton, CRC, 1999.
- Stanger O, Herrmann W, Pietrzik K, Fowler B, Gesisel J, Dierkes J, Weger M, DACH- LIGA Homocysteine: DACH-LIGA homocysteine (German, Austrian and Swiss Homocysteine Society): consensus paper on the rational clinical use of homocysteine, folic acid, and B vitamins in cardiovascular and thrombotic diseases: guidelines and recommendations. Clin Chem Lab Med 2003;41:1392–1403.
National Academy of Sciences: Dietary Reference Intakes (DRI) for Thiamine, Riboflavin, Niacin, Vitamin B6, Vitamin B12, Pantothenic Acid, Biotin and Colin. Washington, National Academies Press, 2000, p 228, 238.
- Osseyi ES, Wehling RL, Albrecht JA: Liquid chromatographic method for determining added folic acid in fortified cereal products. J Chromatogr A 1998;826:235–240.
- Konings EJM, Roomans HHS, Dorant E, Goldbohm RA, Saris WHM, Van den Brandt PA: Folate intake of the Dutch population according to newly established liquid chromatographic data for foods. Am J Clin Nutr 2001;73:765–776.
Elmadfa I, Freisling H: Prevalence of insufficient folate supply and excessive salt intake in Austrian population groups. Ernaehrung 2004;28:295–299.
- Liu S, West R, Randell E, Longerich L, O’Connor KS, Scott H, Crowley M, Lam A, Prabhakaran VM, McCourt C: A comprehensive evaluation of food fortification with folic acid for the primary prevention of neural tube defects. BMC Pregnancy Childbirth 2004;4:20.
- Alfthan G, Laurinen MS, Valsta LM, Pastinen T, Aro A: Folate intake, plasma folate and homocysteine status in a random Finnish population. Eur J Clin Nutr 2003;57:81–88.
Hertrampf E, Cortes F: Folic acid fortification of wheat flour: Chile. Nutr Rev 2004;6:S44–S48.
- Ganji V, Kafai MR: Trends in serum folate, RBC folate, and circulating total homocysteine concentrations in the United States: analysis of data from National Health and Nutrition Examination Surveys 1988–1994, 1999–2000, and 2001–2002. J Nutr 2006; 136:153–158.
- Ray JG, Vermeulen MJ, Boss SC, Cole DE: Declining rate of folate insufficiency among adults following increased folic acid food fortification in Canada. Can J Public Health 2002;93:249.
- Hirsch S, Maza P, Barrera G, Gattás V, Petermann M, Bunout D: The Chilean flour folic acid fortification program reduces serum homocysteine levels and masks vitamin B-12 deficiency in elderly people. J Nut 2002;132:289–291.
Jacques PF, Selhub J, Bostom AG, Wilson PWF, Rosenberg IH: The effect of folic acid fortification on plasma folate and total homocysteine concentrations New Engl J Med 1999;340:1449–1454.
- Honein MA, Paulozzi LJ, Erickson JD, Wong LYC: Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. JAMA 2001;285:2981–2986.
- Persad VL, Van den Hof MC, Dube JM, Zimmer P: Incidence of open neural tube defects in Nova Scotia after folic acid fortification. Can Med Assoc J 2002;167:241–245.
Lammi-Keefe CJ, Couch SC, Philipson EH: Handbook of Nutrition and Pregnancy. New York, Humana, 2008, pp 196–197.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.